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Medicaid Transformation News: Learn more about provider enrollment and the upcoming webinar

Medicaid Transformation News: Learn more about provider enrollment and the upcoming webinar

Publication Date: September 24, 2019

During open enrollment for Medicaid Managed Care, most beneficiaries will choose a health plan and primary care provider (PCP). Those who do not make a choice will be auto-enrolled in a health plan.

PCPs who do not contract with health plans by November 15 risk losing patients, as health plans will enroll beneficiaries only with network providers. If a contract is not in place by Feb. 1, 2020, and the provider has not engaged in good faith negotiations, the provider is at risk for being reimbursed at 90 percent and subject to additional prior authorizations. 

Medicaid has traditionally experienced high provider enrollment rates, which we want to continue. The November 15 deadline allows health plans to process provider contracts and ensure that providers can be paid; this typically takes at least two to three weeks, but it may take longer. Once contracts are executed, health systems and providers become in-network providers with that health plan. Additional time is then needed to transmit information to the Department for inclusion in the auto-enrollment process.

For more details, you can read the Medicaid Special Bulletin and Providing Contracting Q&A sent to associations, providers and other stakeholders. We also will be hosting a Provider Webcast to share the importance of contracting by the deadline, and to answer provider questions. Feel free to join the call if time permits.

PROVIDER WEBINAR September 24, 2019 2-2:30 p.m. Registration required.

Source: NC Medicaid, Division of Health Benefits

North Carolina Department of Health and Human Services